Anti-LRP4 autoantibodies in Chinese patients with myasthenia gravis

Muscle Nerve. 2017 Nov;56(5):938-942. doi: 10.1002/mus.25591. Epub 2017 Apr 8.

Abstract

Introduction: We assessed antibodies against low-density lipoprotein receptor-related protein 4 (LRP4-Ab) in a Chinese population with myasthenia gravis (MG).

Methods: Serum samples from 116 patients and 80 controls were collected. Acetylcholine receptor antibodies(AChR-Ab) and muscle-specific receptor tyrosine kinase antibodies (MuSK-Ab) were tested using an enzyme-linked immune absorption assay, and LRP4-Ab was identified using a cell-based assay. MG patients with neither AChR-Ab nor MuSK-Ab were defined as double-seronegative MG (dSN-MG).

Results: Two of 116 (1.7%) of all patients and 2 of 50 (1%) dSN-MG patients were positive for LRP4-Ab. These 2 patients had ocular MG. Following treatment with acetylcholinesterase inhibitor and prednisone, both achieved full remission.

Conclusions: This study shows that LRP4-Ab is a pathogenic antibody in MG. LRP4-MG seems to be characterized by mild disease severity and favorable therapeutic effect in contrast with other types of MG. Muscle Nerve 56: 938-942, 2017.

Keywords: acetylcholine receptor autoantibodies; clinic presentation; low-density lipoprotein receptor-related protein 4 autoantibodies; muscle-specific tyrosine kinase receptor autoantibodies; myasthenia gravis; pathogenic mechanism.

MeSH terms

  • Adolescent
  • Adult
  • Anti-Inflammatory Agents / therapeutic use
  • Asian People
  • Autoantibodies / blood*
  • Cholinesterase Inhibitors / therapeutic use
  • Female
  • Humans
  • LDL-Receptor Related Proteins / immunology*
  • Male
  • Middle Aged
  • Myasthenia Gravis / blood*
  • Myasthenia Gravis / drug therapy
  • Myasthenia Gravis / immunology*
  • Prednisone / therapeutic use
  • Receptor Protein-Tyrosine Kinases / immunology
  • Receptors, Cholinergic / immunology
  • Retrospective Studies
  • Severity of Illness Index
  • Young Adult

Substances

  • Anti-Inflammatory Agents
  • Autoantibodies
  • Cholinesterase Inhibitors
  • LDL-Receptor Related Proteins
  • LRP4 protein, human
  • Receptors, Cholinergic
  • MUSK protein, human
  • Receptor Protein-Tyrosine Kinases
  • Prednisone